Children's HeartLink (CHL)(CHL) is a nongovernmental, nonprofit organization, founded in 1969 by Dr. Joseph Kiser, headquartered
in Minneapolis, Minnesota, USA (http://www.childrensheartlink.org).
One of the main goals of the organization is to collaborate
in the development, training and mobilizing people and
institutions to help children with heart defects around the
It works in partnership with hospitals recognized as a
benchmark in pediatric cardiovascular surgery in developed
countries to offer continuing education and training,
primarily for professionals involved in clinical and surgical
treatment of children with heart disease in countries like
Ecuador, India, Malaysia, Ukraine, Vietnam, South Africa,
China and now Brazil.
Some time ago, Full Professor Rodolfo A. Neirotti, in
conversation with Full Professor Domingo Braile in
international congresses, demonstrated the possibility of
including Brazil among the countries to be beneficiaries of
a partnership with the CHL.
During the 35th Congress of the Brazilian Society of
Cardiovascular Surgery, held in São Paulo between 18 and
20 April 2008, at request of the CHL, the pediatric
cardiovascular surgeon Full Professor Rodolfo A. Neirotti
came to Brazil with the task of identifying some centers of
pediatric cardiovascular surgery that could be visited and
evaluated for a future partnership.
Full Professor Neirotti is a cardiovascular surgeon with
extensive experience in pediatric cardiovascular surgery,
Master in Public Administration at Harvard University and
volunteer for CHL. Part of his training was performed in
Brazil in the early 60's, with Full Professor E. J. Zerbini.
Therefore, he knew the country well, in addition to maintain
contact with many colleagues of the Brazilian Society of
Cardiovascular Surgery, who at the time could informally
indicate him Services of Cardiovascular Surgery in some
cities in Brazil.
In December 2008, a group representing the CHL, which
currently receives financial support from various sources,
including the Medtronic Foundation, was in Brazil visiting
the predetermined places.
São José do Rio Preto was chosen for having the best
conditions of development, since the city is a wide-range
pioneer in cardiovascular surgery in Brazil.
Participated in this visit the director of international
programs at the time, John Cushing, the coordinator
Andreas Tsakitos, the pediatric cardiologist at Stanford
University School of Medicine, Dr. Paul T. Pitlick, and Full
The visit to the Pediatric Cardiovascular Surgery
Service of São José do Rio Preto, Hospital de Base - São
José do Rio Preto Medical School (HB - FAMERP) lasted
two days. The visiting group explained about the projects
of the CHL and its goals, and noted a statement on who we
were, what we did and how we worked.
It was clear that the partnership program between the
CHL and one center in Brazil would depend on several
factors and would have several stages.
The main factors would be the identification of a site
with potential for the development of pediatric cardiology
and cardiovascular surgery, including the minimum number
of 100 surgeries a year, interest from the medical team and
the board of directors the Hospital in local improvement,
participation in information and responsibilities with mutual
In the case of a possible relationship, there would be
1. Recognition of a site with potential;
2. Local evaluation performed by a volunteer physician;
3. Pilot program with a group to assess the site chosen;
4. Active local participation with education and training,
technical assistance, financial support for treatment of some
patients, critical supplies and equipments;
5. Continued collaboration after a suitable and
consistent level of care.
Our team, guided since the beginning by Full Professor
Domingo Braile, presented itself as a structured Pediatric
Cardiology and Cardiovascular Surgery Service, consisting
of surgeons, pediatric cardiologists, anesthesiologists,
perfusionists, physiotherapists, nurses and other
professionals involved in patient care.
We were able to demonstrate the scientific and academic
participation, the growing number of surgeries, and care to children from all over Brazil, with support from an
Association of Friends of Children with Cancer and Heart
Disease) (www.amicc.com.br) and a company of supply of
the material used in the treatment of children in our country,
Braile Biomédica S/A.
With evidence of the Children's Hospital, in the final
stages of construction, we presented this as an opportunity,
unique and of great impact for future expansion in volume
and quality of care to be provided to children with heart
On May 19, 2009, we received an email from Ms. Estelle
Brouwer, vice-president and director of international
programs, stating that our center was selected by the CHL
for cooperation in Brazil.
The conversations have began and, in July 2009, we
received the second visit of Full Professor Neirotti, as
representative of CHL. During a week he observed the
behaviors, operations and all the routine of our work,
attempting to make a deeper diagnosis of the positives and
negatives points. This analysis was also intended to
prepare the coming of the first complete mission of volunteer
professionals to our country.
We submit the application for the release of medical
activities and other foreign professionals to the Regional
Council of Medicine (CRM) in order to legalize the mission.
HB-FAMERP fully supported the project, preparing
rooms for meetings, mobile phones to facilitate
communication between the teams, transportation, meals
and hiring of translators day and night in all units, a fact
that was of great importance to integration and allowed
information exchange at all levels of care.
In September 2009, the first visit of a group of
professionals from Mayo Clinic took place. This group was
led by Dr. Joseph A. Dearani, a prominent cardiovascular
surgeon and medical director of CHL.
The team of 10 professionals led by Dr. Dearani
consisted of the pediatric cardiologist, Dr. Shanthi
Sivanandam, the anesthesiologist, Dr. Roxann Barnes, the
perfusionist, Dave Clements, nurses, Anita Wattier, Lisa
Belch, Deanna Gage and Jill Misgen, the physiotherapist, Ed Schneider, the surgical technician, Joan Wobig, and Full
The main objectives were to familiarize the team with
our routines, research, service demands and priorities,
seeking a lasting professional relationship, participating in
the diagnosis and treatment of patients, and offering
observations and recommendations aiming at planning the
technological advancement in Hospital.
For a week our team could see and be seen working by
the team of Dr. Dearani. What we have seen in this amazing
experience was a group of volunteer professionals, with
high capacity, very interested in discussing the clinical and
surgical cases, demonstrating their behaviors and how we
could improve the procedures of our routine.
The unquestionable ethical position of the team of Dr.
Dearani was absolutely spectacular, drawing our attention
to the enormous respect for people who work here and our
Immediately we noticed a huge improvement in selfesteem
and the greatest interest of all of our team in
improving the quality of care to children with heart disease.
At the moment, with the help of the CHL, we are initiating
participation in a study group, Quality Improvement
Collaborative for Congenital Heart Surgery, led by Dr.
Kathy Jenkins, from Boston Children's Hospital. The aim is
to identify risk factors for morbidity and mortality, introduce
international standards and compare our outcomes with
those of other centers around the world.
We also began preparations to receive a new team in
June, with attention focused on the overall treatment in the
Finally, we believe that this experience of partnership
with the CHL will result in higher training of professionals
of our team, working as a multiplicative factor for
improvement in caring for children with congenital heart
diseases in Brazil.